This FIRCA application entitled "Smokeless Tobacco Use And Reproductive Health Among Women Users In A Low Income Community Of Mumbai" proposes to explore the use of new and highly addictive forms of smokeless tobacco increasingly used by Indian women during their reproductive years. Smokeless tobacco use is increasing dramatically among women in India and has been shown to contribute to reproductive health problems including premature birth, low birth weight, still birth and maternal morbidity among (low income) Indian women. The study will be conducted with Drs. Saritha Nair, Scientist and Donta Balaiah, Deputy Director and Scientist, National Institute for Research on Reproductive Health, Mumbai and is an extension of NIH Grant number 1 R01 DA020393-01A2. The five study aims are: 1) to conduct qualitative research with a sample of 90 women and 20 community experts in one large low income/slum area of Western Mumbai on the meanings, and practices associated with smokeless tobacco during three stages in reproductive history, immediately post marriage, during first (or second) pregnancy, and between 2nd and 4th pregnancy. 2) to understand marketing, promotion and availability of SL to low income women;3) to conduct a survey with 400 women in one low income/slum area of western Mumbai known to be receptive to prevention studies, approximately 125 in each reproductive health category. 4) to use data to generate and evaluate social acceptability of intervention approaches with women in the study community and others affected by smokeless tobacco use: 5) to increase capacity of NIRRH, the partner organization, to conduct social and behavioral intervention research on smokeless tobacco and reproductive health issues in India through capacity building training on qualitative research methods, tobacco's implications for morbidity and mortality prior to, after and during pregnancy and proposal development. The proposed research will contribute to culturally and contextually appropriate interventions focused on smokeless tobacco prevention and cessation among women in low income communities of Mumbai. Consultants to the study will include P.C. Gupta, Ph.D. internationally recognized expert on tobacco use/control in India and tobacco use, pregnancy and female morbidity and mortality, Stephen Schensul, Ph.D., and partners conducting intervention research in a similar community on life stress (tenshun), perceived reproductive health symptoms (kamjori and safed pani) marital conflict and STI/HIV risk. Other Indian and U.S. consultants will be added to capacity building workshops each year based on topic. Significance lies in the study's capacity to address a critical public health problem in India, the apparent increase in risky and addictive new forms of smokeless tobacco with potentially serious implications for pregnancy and morbidity and mortality of women, and to provide the basis for educational and other forms of appropriate intervention to reduce smokeless tobacco use, a practice intertwined with other aspects of their lives, among women of reproductive age. PUBLIC HEALTH RELEVANCE: This study addresses a significant public health problem unique to the Indian context, the growing use of dangerous and addictive forms of smokeless tobacco among women living in low-income urban communities. New ways of conducting research to highlight the cultural and contextual factors contributing to smokeless tobacco use among women of reproductive age will contribute to the development of situationally and culturally appropriate interventions in the India context, and to multilevel approaches that can be applied to diverse communities of smokeless tobacco users in the U.S.